MEDICARE: KENDRA ZERRUSEN APN, FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	209015782	IL

General Provider Information

NPI Number	:	1134660590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDRA ZERRUSEN APN, FNP-BC

Provider Business Mailing Address
First Line	:	1005 HEALTH CENTER DR STE 201
Second Line	:
City	:	MATTOON
State	:	IL
Zip	:	61938-4653
Country	:	US
Telephone Number	:	217-868-2812
Fax Number	:

Provider Business Practice Location Address
First Line	:	905 N MAPLE ST STE E
Second Line	:
City	:	EFFINGHAM
State	:	IL
Zip	:	62401-6401
Country	:	US
Telephone Number	:	217-347-7030
Fax Number	:	217-347-7197

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2017
Last Update Date	:	09/27/2022

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